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Stage and grade for maxillary sinus cancer

The stage of a cancer tells the doctor how far it has grown or spread. It is important because treatment is often decided according to the stage of a cancer. The staging of maxillary sinus cancer is complicated. There are 2 ways that doctors stage maxillary sinus cancer; the TNM system and the number system.

Number stages

There are 5 stages in this system – stages 0 to 4. Stage 0 is a very early stage cancer. Some doctors prefer to call this pre cancer because there are cancer cells only in the skin like tissue covering your maxillary sinus. This means the cancer cells are contained there and cannot spread. If it is not treated, there is a high chance of this condition going on to develop into an invasive cancer. Stage 1 is the earliest stage of invasive cancer. Stage 4 means the cancer is advanced.

Grade

The grade of a cancer tells you how much the cancer cells look like normal cells. There are 3 grades of maxillary sinus cancer. Grade 1 is low grade. This means the cancer cells look very much like the normal maxillary sinus cells. Grade 2 is intermediate grade. And grade 3 is high grade, meaning the cancer cells look very abnormal. Low grade cancers are usually slower growing and less likely to spread. High grade cancers are likely to be faster growing and are more likely to spread.

What staging is

The stage of a cancer tells the doctor how far a cancer has grown or spread. It is very important because the stage often decides the treatment. The tests and scans that you have when your doctor is diagnosing your cancer will give you some information about the stage. But your doctor may not be able to tell you the exact stage until after you have surgery.

TNM stages of maxillary cancer

T stage

T1 means the tumour is only in the innermost most tissues lining the sinus. It has not grown into the bone.

T2 means the tumour has begun to grow into the bone surrounding the maxillary sinus. (If the tumour is in the bone in the back part of the sinus - the posterior wall - it is T3.)

T3 means the tumour has begun to grow into the back (posterior) wall or into bones of any of the other sinuses. If the cancer grows right through these bones it may reach the tissues under the skin, the skin of the cheek, the eye socket or the ethmoid sinus in front of the maxillary sinus.

T4 means the tumour has grown into any other nearby structures such as the eye, skull, skin of the cheek, the tissues below the temple, the area connecting the back of the nose to the back of the mouth (nasopharynx) , sphenoid or frontal sinuses or up into the brain.

There are actually 2 parts to T4. These are T4a and T4b. But the definitions of these are so complicated and technical that we haven’t gone into them here.

N stage

There are 4 main lymph node stages in maxillary sinus cancer, although N2 is divided into 3 parts. These are 2a, 2b and 2c. The important points here are whether there is cancer in any of the lymph nodes, and if so, how big they are and where they are.

N0 means there are no lymph nodes containing cancer cells

N1 means there are cancer cells in one lymph node on the same side of the neck as the tumour and the node measures 3cm across or less

N2a means there is cancer in one lymph node, on the same side of the neck, that is more than 3cm across but no more than 6cm across

N2b means there is cancer in more than one lymph node on the same side of the neck, but none of them are more than 6cm across

N2c means there is cancer in lymph nodes on the other side of the neck (or on both sides) but none are more than 6cm across

N3 means that one or more nodes contain cancer and at least one node is more than 6cm across

M stage

There are 2 stages to describe spread of cancer of the maxillary sinuses to other parts of the body

M0 means there is no cancer spread to other parts of the body

M1 means the cancer has spread to other parts of the body, such as the lungs, brain or liver

Together, the T, N and M stages give a complete description of the stage of your cancer. For example, if you have a T2, N0, M0 cancer of the maxillary sinuses, you have a tumour that has begun to grow into other sinuses. The lymph nodes are clear and there is no spread of your cancer to other parts of the body.

Number staging for maxillary sinus cancer

If you have CIS or stage 0 cancer of the maxillary sinus, you have a very early stage cancer. Some doctors prefer to call this pre cancer because there are cancer cells only in the skin like tissue covering your maxillary sinus. This means the cancer cells are contained there and cannot spread. As the cells cannot spread, this is not yet a true cancer. If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.

The cancer has begun to grow into any of the other sinus bones. If the cancer grows through these bones, it may reach the tissues under the skin, the skin of the cheek, the eye socket or the ethmoid sinus in front of the maxillary sinus. It has not spread to the lymph nodes or other organs.

The tumour is any size, except T4, and has spread to one lymph node on the same side of the neck. The lymph node is no more than 3cm across.

This means the cancer is advanced. All T4 tumours are considered to be stage 4 even if they have not spread to lymph nodes or other parts of the body. Stage 4 could mean one of 3 things

The tumour has grown into other nearby structures such as the eye, the skull, the area connecting the back of the nose to the back of the mouth (nasopharynx), or into the sphenoid or frontal sinuses. It may also have spread to one lymph node on the same side of the neck, but the node is less than 3cm across.

The cancer is any size, has spread to more than one lymph node on the same side of the neck and at least one node is bigger than 3cm. Or there are several cancerous lymph nodes of any size. Or there are lymph nodes of any size on the other side of the neck.

The cancer has spread to other parts of the body such as the lungs, liver or brain

The word differentiation means how developed or mature a cell is. So you may hear your doctor describe grade 1 cancer cells as well differentiated. Grade 2 cancer cells are moderately differentiated. Grade 3 cancer cells are poorly differentiated.

The grade of the cancer gives your specialist a guide as to how the cancer is likely to behave. Low grade cancers are usually slower growing and less likely to spread. High grade cancers are likely to be faster growing and are more likely to spread. This is only a guide. Your specialist will consider all your test results, and the stage of the cancer (see above) when deciding which treatment is best for you.

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